P.25 Improving antenatal anaesthetic assessment and dissemination of information to parturients with a high body mass index

Introduction: Parturients with a body mass index (BMI) greater than 40 kg/m2 should be referred to the anaesthetic clinic for antenatal assessment.1We assessed parturients’ understanding of high BMI and the additional risks posed to them in order to improve their anaesthetic assessment. This has particular importance due to COVID-19 when most assessments have taken place over the telephone. Methods: All patients were sent the Obstetric Anaesthetists’ Association (OAA) high BMI leaflet2 by text message one week before their clinic appointment. The aim was to increase patients’ knowledge base prior to the appointment. A survey was conducted to assess patients’ understanding of high BMI, the reason for their referral to the anaesthetic clinic and additional intrapartum risks posed to them. Data including timing of referral and anaesthetic clinic, specialty of referrer and patients’ BMI were collected as well as patient preferences for information dissemination. Results: 21 patients were surveyed over a nine-week period. The mean BMI was 42 kg/m2. 71% patients understood the meaning of high BMI but only 29% understood why they had been referred to the anaesthetic clinic. 48% patients claimed that they understood the additional risks but only 60% of those could actually comment on what those risks were. 62% of patients were referred to the anaesthetic clinic by a midwife but only 23% of those were at the booking appointment. The mean timing of referral was 21 weeks gestation with mean timing of the anaesthetic clinic at 28 weeks (maximum gestation was 38 weeks). 86% patients had the maternity app for online notes and would like information leaflets to be uploaded there. Discussion: Despite a limitation in case numbers, this survey shows that patients’ understanding of their reason for referra l to anaesthetic high-risk clinic and additional risks posed to them due to high BMI is generally poor. Referral to the anaesthetic clinic is not systematic resulting in some patients reviewed late in their gestation. In order to improve the antenatal anaesthetic clinic service, we have introduced several measures. These include a new electronic referral form, education of antenatal midwives to refer women at their booking appointment once height and weight have been checked and to aim for an anaesthetic clinic appointment at 24–30 weeks gestation. At the time of referral, patients are informed of the reason and directed towards information leaflets which will be uploaded onto their maternity app. We hope these measures will increase patients’ understanding and engagement with the service and we will re-evaluate them once they have been established.